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Mercadante S, Ferrera P, Lo Cascio A, Casuccio A. Pain Catastrophizing in Cancer Patients. Cancers (Basel) 2024; 16:568. [PMID: 38339319 PMCID: PMC10854960 DOI: 10.3390/cancers16030568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Pain catastrophizing is a group of negative irrational cognitions in the context of anticipated or actual pain. The aim of this study was to decipher the possible role of catastrophism on pain expression and outcomes after a comprehensive palliative care treatment. METHODS A consecutive sample of patients with uncontrolled pain was assessed. Demographic characteristics, symptom intensity included in the Edmonton symptom assessment system (ESAS), and opioid drugs used were recorded at admission (T0). The Pain Catastrophizing Scale (PCS) was measured for patients. Patients were also asked about their personalized symptom goal (PSG) for each symptom of ESAS. One week after a comprehensive palliative care treatment (T7), ESAS and opioid doses used were recorded again, and the number of patients who achieved their PSG (PSGR) were calculated. At the same interval (T7), Minimal Clinically Important Difference (MCID) was calculated using patient global impression (PGI). RESULTS Ninety-five patients were eligible. A significant decrease in symptom intensity was reported for all ESAS items. PGI was positive for all symptoms, with higher values for pain, poor well-being, and poor sleep. Only the rumination subscale of catastrophism was significantly associated with pain at T0 (B = 0.540; p = 0.034). CONCLUSIONS Catastrophism was not associated with the levels of pain intensity, PSG, PSGR, and PGI for pain, except the rumination subscale that was associated with pain intensity at T0. A comprehensive palliative care management provided the relevant changes in symptom burden, undoing the pain expression associated with rumination.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy (A.L.C.)
| | - Patrizia Ferrera
- Main Regional Center of Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy (A.L.C.)
| | - Alessio Lo Cascio
- Main Regional Center of Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy (A.L.C.)
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy;
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Moore A, Tumin D. Overlap of pain-related and general measures of disability among adults with chronic pain. Pain Pract 2024; 24:62-71. [PMID: 37534395 DOI: 10.1111/papr.13281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/10/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Chronic pain is known to be correlated with disability. We aimed to determine the overlap between a general self-reported measure of disability and a measure of disability due to pain problems among adults with chronic pain. MATERIALS AND METHODS We used data from the National Health Interview Survey (NHIS) and analyzed respondents with chronic pain in the past 3 months. General disability was defined as being limited in the kind or amount of work one can do due to any physical, mental, or emotional problem. Pain-related disability was defined as pain limiting one's activity on "most days" or "every day." RESULTS Based on a sample of 6874 respondents with chronic pain, 58% had either kind of disability, including 9% who reported only pain-related, but not general disability; and 27% who reported both types of disability. Respondents reporting only pain-related, but not general disability tended to be younger and had lower rates of obesity, smoking, diabetes, and hypertension than respondents reporting both pain-related and general disability. DISCUSSION Among people with chronic pain, most people with disability are experiencing limitations related to pain problems. Assessment of disability without addressing pain interference has likely underestimated the disability burden in this population.
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Affiliation(s)
- Ashley Moore
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP, Miró J. Psychological factors and pain medication use in adolescents with chronic pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1183-1188. [PMID: 37341626 DOI: 10.1093/pm/pnad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/20/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this study was to examine (1) the associations of anxiety, depressive symptoms, and pain catastrophizing with pain medication use in adolescents with chronic pain and (2) the extent to which these associations differed as a function of adolescents' sex. METHODS Cross-sectional data from 320 adolescents 12-18 years of age with chronic pain were drawn from an epidemiological study on pediatric chronic pain conducted in Reus (Catalonia, Spain). Participants were asked to provide sociodemographic information and respond to measures assessing pain (location, frequency, intensity, and interference), pain medication use, anxiety, depressive symptoms, and pain catastrophizing. Point biserial correlations were conducted to examine univariate associations between the psychological variables and pain medication use. Hierarchical logistic regression analysis was used to examine these associations while controlling for demographic characteristics, pain intensity, and pain interference. RESULTS Anxiety, depressive symptoms, and pain catastrophizing were significantly associated with pain medication use in univariate analyses. Regression analysis identified pain catastrophizing as a unique independent predictor of pain medication use after controlling for the effect of demographic variables (sex and age), pain intensity, and pain interference (odds ratio = 1.1, P < .05). No moderating effect of adolescents' sex on the associations between psychological factors and pain medication use was found. CONCLUSIONS Adolescents with chronic pain with higher levels of pain catastrophizing use pain medications more often. Research to examine the impact of interventions targeting pain catastrophizing on pain medication use among adolescents with chronic pain would be an important next step.
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Affiliation(s)
- Josep Roman-Juan
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, United States
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
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Forget P, Kahtan H, Jordan A. Personalized pain assessment: What does 'acceptable pain' mean to you? Eur J Pain 2023; 27:1139-1143. [PMID: 37565743 DOI: 10.1002/ejp.2166] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND What 'acceptable pain' means may be different for everyone and dependent on the moment and the context. In this text, we explore the concepts of pain acceptability and acceptance. We explain why we need to better explore (un)acceptable pain, to eventually facilitate pain assessment and management. METHODS Using different approaches and perspectives (with examples and application from multiple disciplines, i.e. orthopaedics, psychology, pharmacological therapy), we discussed anecdotal examples and included a systematic, scoping and literature review. RESULTS We rejected the idea that in the context of chronic pain, acceptability, disability and manageability overlap neatly. Additionally, we rejected the validity of pain intensity rating scales to sufficiently explore individuals' experience of pain. In the one study that met our criteria, a definition of 'acceptable pain' was dropped as participants deemed it inappropriate because it did not address the significant challenges associated with pain. This is important, however, because the acceptability of pain may precede, follow and/or inform the 'pain acceptance' process, which is an important concept associated with better outcomes. CONCLUSIONS Very little is known regarding what 'acceptable pain' may mean to people living with pain. Qualitative studies may improve our understanding of individuals' perceptions, perspectives and expectations as we do not know, for the moment, what 'acceptable pain' may mean to a particular person and, potentially, regarding a specific treatment or other contextual aspects that are not captured with currently used scores and quantitative measures. SIGNIFICANCE What does 'acceptable pain' mean may differ between people with painful experiences and may depend on contextual factors. Pain acceptability may be distinct from manageability, and may precede, follow and/or inform the 'pain acceptance' process. This text, rigorously based on a review of the existing literature, defends the idea that acceptable pain should be better studied.
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Affiliation(s)
- Patrice Forget
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Anaesthetics, NHS Grampian, Aberdeen, UK
- Pain and Opioids after Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care (ESAIC) Research Group, Brussels, Belgium
| | - Hanaa Kahtan
- Department of Psychology, University of Bath, Bath, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Centre for Pain Research, University of Bath, Bath, UK
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Wang R, Zheng X, Su X, Huang X, Liu H, Guo Y, Gao J. Chinese Oral Cancer Patients' Pain Beliefs: An Application of Leventhal's Common-Sense Model. Pain Manag Nurs 2023; 24:e115-e122. [PMID: 37270324 DOI: 10.1016/j.pmn.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Patients' pain beliefs are the main obstacle to effective pain management. Assessing and correcting negative perceptions is important for improving pain intensity and quality of life of patients with cancer pain. AIMS To explore pain beliefs among oral cancer patients using the Common-Sense Model of Self-Regulation as a theoretical framework. The primary components of the model, cognitive representations, emotional representations, and coping responses, were examined. DESIGN A qualitative method was used. SETTINGS PARTICIPANTS/SUBJECTS: METHODS: Semi-structured, qualitative, in-depth interviews were conducted with patients newly diagnosed with oral cancer in a tertiary care hospital. The interviews were analyzed using thematic analysis. RESULTS Interviews with 15 patients revealed that the pain beliefs of patients with oral cancer included three themes: pain cognitive representations of oral cancer, pain emotional representations of oral cancer, and pain coping responses. CONCLUSIONS Negative pain beliefs are common among oral cancer patients. This novel application of the self-regulatory model demonstrates that it can be used to capture the key pain beliefs (i.e., cognitions, emotions, and coping responses) of oral cancer patients within a single, unifying framework.
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Affiliation(s)
- Rongna Wang
- The School of Nursing, Fujian Medical University, No.1 Xueyuan Road, Shangjie, Minhou, Fuzhou, Fujian, China
| | - Xiaoyan Zheng
- First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Xixi Su
- The School of Nursing, Fujian Medical University, No.1 Xueyuan Road, Shangjie, Minhou, Fuzhou, Fujian, China
| | - Xiuyu Huang
- The School of Nursing, Fujian Medical University, No.1 Xueyuan Road, Shangjie, Minhou, Fuzhou, Fujian, China
| | - Huangju Liu
- The School of Nursing, Fujian Medical University, No.1 Xueyuan Road, Shangjie, Minhou, Fuzhou, Fujian, China
| | - Yulai Guo
- The School of Nursing, Fujian Medical University, No.1 Xueyuan Road, Shangjie, Minhou, Fuzhou, Fujian, China
| | - Ji Gao
- The School of Nursing, Fujian Medical University, No.1 Xueyuan Road, Shangjie, Minhou, Fuzhou, Fujian, China.
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Reward drive moderates the effect of depression-related cognitive mechanisms on risk of prescription opioid misuse among patients with chronic non-cancer pain. THE JOURNAL OF PAIN 2022; 24:655-666. [PMID: 36442816 DOI: 10.1016/j.jpain.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Depression, a prognostic factor for prescription opioid misuse commonly occurs in people with chronic non-cancer pain (CNCP). However, the mechanisms linking depression and prescription opioid misuse remain unclear. This study examined the potential mediating role of pain catastrophizing in the association between depressive symptoms and prescription opioid misuse risk, and impulsivity traits as possible moderators of these relationships. Individuals (N = 198; 77% women) with CNCP using prescription opioids participated in a cross-sectional online survey with validated measures of depression, pain catastrophizing, rash impulsiveness, reward drive, anxiety, pain severity and prescription opioid misuse. Meditation analyses with percentile-based bootstrapping examined pathways to prescription opioid use, controlling for age, sex, pain severity, and anxiety symptoms. Partial moderated mediation of the indirect effect of depressive symptoms on prescription opioid misuse risk through pain catastrophizing by rash impulsiveness and reward drive were estimated. Pain catastrophizing mediated depressive symptoms and prescription opioid misuse risk. Indirect effects were stronger when moderate to high levels of reward drive were included in the model. Findings suggest the risk of prescription opioid misuse in those experiencing depressive symptoms and pain catastrophizing is particularly higher for those higher in reward drive. Treatments targeting these mechanisms may reduce opioid misuse risk. PERSPECTIVE: This article identifies reward drive as a potentially important factor increasing the effects of depression-related cognitive mechanisms on risk of prescription opioid misuse in those with CNCP. These findings could assist in personalizing clinical CNCP management to reduce the risks associated with opioid misuse.
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